Healthcare Provider Details

I. General information

NPI: 1306183652
Provider Name (Legal Business Name): DONNA MAY MEJIA RIGBY IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST MEDICAL BATTALION BOX 555657
APO AP
92055-5657
US

IV. Provider business mailing address

242 CANDERA LANE
SAN MARCOS CA
92069
US

V. Phone/Fax

Practice location:
  • Phone: 619-876-8229
  • Fax:
Mailing address:
  • Phone: 619-876-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: